Goodroot

For years, issuers have managed their own justification forms alongside the Plan & Benefit Template submission process. But that’s changing. CMS is shifting the justification form into the MPMS portal, limiting access to just two users per organization. That means issuers need to be proactive—ensuring the right people have access and staying ahead of new workflow challenges. This shift will impact compliance, communication, and submission timelines. Is your team ready? Watch the latest episode of #RegulatoryJoe to learn how to prepare: https://hubs.li/Q03c3zVC0 #RegulatoryCompliance #HealthPlans #CMS #MPMS #PlanAndBenefitTemplate Joe Boyle

Your team's next payment integrity idea could be a game-changer—or a dead end. The best concepts don’t just sound good in theory; they need to solve real problems, create measurable impact, and align with broader strategic goals. Without a structured evaluation process, teams risk investing time and resources in concepts that won’t deliver results. Nichole Russ, VP of Payment Integrity at Penstock, shares four critical questions every team should be asking before moving forward. Swipe through to see how you can identify concepts that will drive real impact! #PaymentIntegrity #ClaimsManagement #HealthcareFinance

The biosimilar shift is here. Are you ready???? With?#Humira biosimilars gaining traction?and?#Stelara biosimilars launching for the first time, 2025 marks a major turning point in specialty pharmacy. More options mean greater opportunities for cost savings—but only with the right strategy. Swipe through to see what’s changing and what plan sponsors should do next. #Biosimilars #PharmacyBenefits #SpecialtyPharmacy #BenefitsManagement

A $70,000 surgery bill—gone. Health share plans exist to help members manage medical costs, but without the right support, a single bill can put financial strain on both the member and the collective pool. When one plan faced a massive hand surgery charge, Emry’s BillAssist stepped in. We secured a massive self-pay discount?and guided the member through hospital financial assistance to eliminate the entire bill. This isn’t just about savings. It’s about ensuring that members and plans aren’t burdened by avoidable costs. Message us today to discover how BillAssist is changing the game. #HealthcareAdvocacy #HealthPlans #MedicalDebt

Issuers have long submitted Justification Forms alongside their Plan and Benefit Template—but in 2026, that process is getting an overhaul. Starting next year, CMS will generate these forms post-submission within the MPMS portal, shifting the timing and control of the process. This means issuers need a new approach to ensure smooth plan approvals and compliance. In the latest episode of Regulatory Joe,?Joe Boyle?breaks down what this means for issuers, key steps to prepare and why strategies like proactive validation and version control will be more critical than ever. Tune in now on YouTube or wherever you listen to podcasts: https://lnkd.in/dgYfyX9j #HealthPlans #HealthPlanStrategy #MPMS #HealthInsurance #RegulatoryJoe

When benefits are easy to access and navigate, everyone wins. Support teams spend less time answering repetitive questions, members make informed decisions, and TPAs can focus on what matters most—delivering exceptional service. So how do you know if your tech is working for you? Swipe through to see 5 signs it might be time for an upgrade—and how the right platform can drive better engagement, efficiency, and scalability. Want to learn more? Download our guide for TPAs navigating member tech: https://lnkd.in/eTQSNY5N #TPATech #BenefitsInnovation #SelfFunded #MemberEngagement #DigitalHealth

Health insurance should protect people from financial ruin—not be the reason they face it. Yet, today’s health plans are structured in a way that prioritizes margins over members, leaving families and employers feeling abandoned. In a new article for?STAT, Goodroot CEO?Michael Waterbury?shares a critical call to action: Health plans must take accountability for the broken system. This isn’t just about profitability—it’s about responsibility. Health plans have the power to shift the system. The question is: Will they? Read the full article now:?https://lnkd.in/ezUaytMd #HealthPolicy #HealthInsurance #MedicalDebt

Steve Palma never set out to patch a broken system—he set out to fix it. From rebuilding a Special Investigations Unit and launching an innovative biological drug audit program in the '90s to leading Penstock, a company redefining payment integrity, his focus has always been on making sure payment accuracy isn’t an afterthought, but a given. As Penstock continues to grow, its mission remains clear: to help payers fix the system—not just profit from its dysfunction. Learn how Steve is?making it happen in the article below! ? #PaymentIntegrity #HealthPlans #Leadership #ClaimsManagement?

A proactive approach to pharmacy benefits starts here—let’s talk GLP-1s and rebates. With GLP-1 utilization on the rise, employers and health plans are navigating coverage challenges and rising costs. At the same time, many organizations assume their PBM rebate reconciliations are accurate—but without an independent review, potential savings may be missed. This month, we’re breaking down two key pharmacy benefit topics: ?? GLP-1s, Weight Loss & Rising Drug Spend ?? The Power of Independent PBM Rebate Reconciliation Get our experts' insights below! #PharmacyBenefits #GLP1s #PBMContracts #DrugSpending Beckie Fenrick, Pharm D Emily Crisano PharmD, RPh Jason Peterson Bethany Hruschak

Managing your healthcare should feel personal—and that’s exactly what we deliver. Robert and his family experienced firsthand the difference that expert advocacy and high-touch support can make. From navigating complex care to resolving billing challenges, Emry Concierge ensures that every member gets the attention they deserve. Discover how we make healthcare simple, seamless, and tailored to you:?emryhealthconcierge.com #HealthcareAdvocacy #ExecutiveSupport #LifestyleDesign